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Review
. 2002 Jan 19;324(7330):160-3.
doi: 10.1136/bmj.324.7330.160.

Science, medicine and the future: healing chronic wounds

K G Harding  1 , H L Morris, G K Patel
Affiliations
Review

Science, medicine and the future: healing chronic wounds

K G Harding et al. BMJ. .

Abstract

Greater interest in wound healing is needed to ensure higher standards of basic care. Precise identification of the systemic, local, and molecular factors underlying the wound healing problem in individual patients should allow better tailored treatment. Allogeneic skin grafting and bioengineered skin equivalents are being used successfully in patients with venous leg ulcers and diabetic patients with foot ulcers.

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Figures

Figure 1
Figure 1
Fundamental interrelation of the wound healing phases—inflammation (blue), proliferation (green), and tissue remodelling (yellow). The inflammatory phase is thought to coordinate wound healing, but we do not understand the true complexities of the process10
Figure 2
Figure 2
Dermagraft—non-immunogenic neonatal fibroblasts cultured on a polyglactin mesh—is being investigated for treating diabetic foot ulcers. The dressing is stored frozen, and, after warming in a saline bath, the edges are trimmed (top) so that when it is applied to the wound it lies within the ulcer boundary (bottom)
Figure 2
Figure 2
Dermagraft—non-immunogenic neonatal fibroblasts cultured on a polyglactin mesh—is being investigated for treating diabetic foot ulcers. The dressing is stored frozen, and, after warming in a saline bath, the edges are trimmed (top) so that when it is applied to the wound it lies within the ulcer boundary (bottom)
Figure 3
Figure 3
Apligraf—a bilayered skin equivalent containing newborn dermal fibroblasts in a bovine collagen matrix with overlying epidermal cells—is currently licensed to treat venous leg ulcers and diabetic foot ulcers. It comes frozen lying on a culture gel (top). Small slits are made in it, after which it is trimmed and laid onto the wound surface so that the edges overlie the ulcer edge (bottom)
Figure 3
Figure 3
Apligraf—a bilayered skin equivalent containing newborn dermal fibroblasts in a bovine collagen matrix with overlying epidermal cells—is currently licensed to treat venous leg ulcers and diabetic foot ulcers. It comes frozen lying on a culture gel (top). Small slits are made in it, after which it is trimmed and laid onto the wound surface so that the edges overlie the ulcer edge (bottom)
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Comment in

References

    1. Harding KG. The future of wound healing. In: Leaper DJ, Harding KJ, editors. Wounds: biology and management. Oxford: Oxford University Press; 1998. p. 191.
    1. Currie CJ, Morgan CL, Peters JR. The epidemiology and cost of inpatient care for peripheral vascular disease, infection, neuropathy and ulceration in diabetes. Diabetes Care. 1998;21:42–48. - PubMed
    1. Reiber GE. Diabetic foot care: financial implications and practical guidelines. Diabetes Care. 1992;15(suppl 1):29–31. - PubMed
    1. Ruckley CV. Socio-economic impact of chronic venous insufficiency and leg ulcers. Angiology. 1997;48:67–69. - PubMed
    1. Waterlow J. Prevention is better than cure. Nurs Times. 1988;84:69–70. - PubMed

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